Cloaca in 4-Year-Old Female Patient with Total Urinary Incontinence (Hendren Patient Case)

Case Overview: 
  • 4-year-old female patient with total urinary incontinence
  • Cloaca with features seen in clocal exstrophy
  • Ileocolic junction originally joined bladder
  • Distal colon originally joined bladder
  • Distal colon originally ended blindly
  • Two adjoining bladders
  • After an endoscopy 2 weeks later there was reasonable outlet resistance
Follow Up: 
  • At age 8 years, in 1992, patient returned for evaluation
  • Urodynamic study showed leakage at even low pressure
  • No reflux
  • Normal kidneys
  • Further narrowing of bladder outlet and urethra was performed in a 7-hour procedure
  • She returned home, a distant rural area, and was on intermittent catheterization by her mother
  • No further follow-up for her was proven possible
  • The plan, if she was still wet, was to close the bladder neck and make a catheterizable bowel segment on the abdominal wall or umbilicus
  • Nearly all patients can be made dry if the surgery and the patient (or family) persist
  • Communication about complicated patients has become much less conscientiously pursued in recent times. This defeats long-term follow-up, which is so important for these patients.
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